Ask Nurses and Doctors: Many Covid Patients; Federal Vaccine Push; Misinformation

I’ve had many Covid positive patients over the past month. None of them are very sick. Until Monday. This patient developed Covid after an outbreak at the nursing home where she worked. I prescribed Paxlovid and she was initially told by her insurer that she had to pay $84. After much effort (her Covid was work related!) the employer figured out how to not charge for the Paxlovid. During the most recent week of data available (September 17-23), the U.S. reported about 19,100 new COVID-19 patients admitted to hospitals, according to the CDC; a 13% lower concentration of SARS-CoV-2 in wastewater than the prior week.

What to do? Please get vaccinated!! I got mine. The CDC has advised that every American older than 6 months should receive one shot of the updated Covid-19 vaccine. Also, every American household is eligible to order up to four free at-home Covid-19 rapid test kits. The vaccine is the most important tool available to prevent hospitalizations and deaths — and perhaps the area where the government’s test will be greatest, given the anti-vaccine movement that flourished during the pandemic. Less than 1 in 5 Americans got previously updated versions of the vaccine that targeted the omicron variant. Even for people over 65, who are most vulnerable, less than half received the bivalent booster. For those skeptical of Paxlovid, a recent review of outpatient Covid treatment showed that it reduced hospitalization or death by 86% compared with placebo. The National Academy of Sciences just summarized vaccination acceptance strategies.

U.S. Covid and all cause mortality is much higher than other similar countries. A recent article specified “how many deaths would have been averted each year, 1933-3031, if US age-specific mortality rates had equaled the average of 21 other wealthy nations: In the pandemic years of 2020 and 2021, the U.S. would have lost 2.1 million fewer people. Between 1980 and 2019, 335 million fewer years of life would have been lost”. Tragically, mortality has particularly impacted Republicans and the poor. Transmissible diseases, such as syphilis, that should never occur with adequate public health are skyrocketing. This article highlights the important public health historical role of black nurses in the fight against Tb.

Many of us have looked to Europe and Canada as models of universal coverage. Yet, this article discusses in detail how “a rapidly ageing population, growing healthcare worker shortages, underinvestment in health systems and external shocks such as climate change and inflation driven by the Russian invasion of Ukraine are putting Europe’s healthcare systems through a battery of stress tests as the bloc looks to move on from the COVID-19 pandemic.”

Our health system is stressed. According to The Guardian, Doctors are dying by suicide at higher rates than the general population. Somewhere between 300 to 400 physicians a year in the US take their own lives, the equivalent of one medical school graduating class annually. Surgeons have some of the highest known rates of suicide among physicians. Of 697 physician suicides reported to the CDC’s national violent death reporting system between 2003 and 2017, 71 were surgeons. Many more go unreported.

In my just published book I argue for closer coordination, using community health workers (CHWs), between acute and public health systems. But CHWs are not valued throughout the world. As reported in the NY Times, 86 % of CHWs are unpaid in Africa; now CHWs are beginning to organize; in Kenya they now get $25/month.

Within acute systems in the U,S., primary care is now on life support.

Misinformation together with charismatic authoritarian leadership are among the key challenges to any democracy. Sadly, as the Post highlighted, misinformation research is “buckling” under the onslaught of Republicans. From the Post: “the National Institutes of Health froze a $150 million program intended to advance the communication of medical information, citing regulatory and legal threats. Physicians … had planned to use the grants to fund projects on noncontroversial topics such as nutritional guidelines and not just politically charged issues such as vaccinations that have been the focus of the conservative allegations. NIH officials sent a memo in July to some employees, warning them not to flag misleading social media posts to tech companies and to limit their communication with the public to answering medical questions.”

Misinformation has had political consequences with at least some towns with large health care facilities voting Democratic and the GOP getting annoyed with the AMA for its science-based pronouncements. The AMA could be doing more in a bipartisan manner.
Ask Nurses and Doctors is exploring how we can impact misinformation such as in Florida, engage health professional associations to increase vaccine support (in the face of a myriad of challenges) and grow our networks in swing states and districts. We also need possible bipartisan efforts as this article demonstrates on child/ family support and decreasing maternal mortality while fighting against, for example, high deductible plans which will simply discriminate against the sick. We welcome your engagement

Norbert Goldfield, M.D.

Founder, Executive Director Healing Across the Divides
Author of Peace Building Through Women’s Health: Psychoanalytic, Sociopsychological, and Community
Perspectives on the Israeli-Palestinian Conflict (Routledge, Taylor Francis; 2021);
Author of Public Health, Public Trust and American Fragility in a Pandemic Era: The Critical Role of Health Care
Professionals (Routledge, Taylor Francis; September 2023).